| National Provider Identifier [NPI]: | 1720361090 |
| Last Name Of The Provider | FRIEDRICK |
| First Name Of The Provider | GAIL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4100 LAKE DR SE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495468292 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 791 |
| Number Of Medicare Beneficiaries | 137 |
| Total Submitted Charge Amount | 69276 |
| Total Medicare Allowed Amount | 32520.86 |
| Total Medicare Payment Amount | 25014.18 |
| Total Medicare Standardized Payment Amount | 30294.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 354 |
| Total Drug Medicare AllowedAmount | 209.4 |
| Total Drug Medicare PaymentAmount | 205.2 |
| Total Drug Medicare Standardized Payment Amount | 205.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 776 |
| Number Of Medicare Beneficiaries With Medical Services | 137 |
| Total Medical Submitted Charge Amount | 68922 |
| Total Medical Medicare Allowed Amount | 32311.46 |
| Total Medical Medicare Payment Amount | 24808.98 |
| Total Medical Medicare Standardized Payment Amount | 30089.42 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 58 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 107 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.0773 |